Consumer-driven fire department (lesson for Canada and U.S.)
Fire fighters rescue the highest bidder
YouTube
video (40 seconds):
http://www.youtube.com/watch?v=bnjQ3cV4×1I
Comment:
By Don McCanne, MD
Though not quite so graphic, free market private health insurance is not unlike the rescue purchased by this unfortunate lady. Just as she purchased a contract to avoid hitting the ground when she jumped from this burning building, private health insurance is purchased to prevent financial hardship or bankruptcy in the face of medical need. It doesn’t always work.
Private enterprises, whether for fire protection or for the financing of health care, work by the rules of the market wherein money sets priorities. Access is subject to the vagaries the market. Public services, whether fire protection or a public national health program, work by the rules of social solidarity wherein human decency sets priorities. Public services are always there when you need them.
There is a difference.
In all fairness, this fictional bit of sick humor could be used by the opponents of a public national health program to point out that queues are a problem in public systems. Even there, many public health systems do not have excessive queues since they monitor and adjust capacity as needed, and apply queue management techniques when appropriate, all in the interests of better public service. Private health systems attempt to reduce queues for well funded patients, but they also oppose adequate funding of the public systems in order to create a greater market demand from those who can buy their way to the front of the inevitably longer queues.
We are seeing a renewal of legal challenges by Brian Day and his colleagues in Canada to create an artificial private market for health care. Just as limiting capacity in the public fire department theoretically would open up the opportunity for private entrepreneurial protection, Day is attempting to convince the courts that wealthier Canadians should have the right to pay extra to the private sector in order to bypass public queues. He contends that relieving the pressure in the public system reduces public queues, but all evidence is that two-tiered systems result in greater impairment of access in the public welfare system (think of Medicaid and the lack of willing providers, especially in the lucrative procedure-oriented specialties, who who seek the security of the better-funded private sector).
There really is a difference.